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0011-066 (SFD)i� U) N U) W Ouch u7 ' W o Z r_ �0o I.—H(D JVr- F-a U) Z LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pr6issionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: * I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or.offered for sale (Sec. 7044, Business & Professionals Code). ( I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). 1 ( ) I am exempt under Section B&P.0for this reason �1. . Date �1 J Signature of Owner ; �^' �tA—ZA�t'i` WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My. workers' compensation insurance carrier & policy no. are: Carrier Policy N0. - (This section need not be completed if the permit valuation is -for $100.00 or less). ()„scertify that in the performance of the work -for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree thatifI should become subject to the workers' compensation'provisions of Sectio' 3700 of the Labor Code, I shall forthwith comply withJhose provisions. y' Dater Applicant r` t -11 A , 1,4©- . ' /fit'' Warning: Failure to secdre Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and 'restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to R any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purpos I r ,,// Signature (Owner/Agent) 1'r% /_ Date �7 f BUILDING PERMIT PERMIT# DATE f VALUATION LOT 0011" TRACT JOB SITE " ° APN ADDRESS '52.-715 AVRMA JYJA Z 77.14-281-02A OWNER CONTRACTOR / DESIGNER / ENGINEER J0J%T 11.1 NeWH O'wN M BIMA)MI USE OF PERMIT S; SFD PERMIT DOES NOT NCLUDED BLOCKWALL/POOL/ DRIVEWAY APPROACH TRACT CONSTRUCTION I,W.00 9F PORCHOATIO 162.00 Sir GARAGWC,#+,RPORT CJF) 2020100 5 ISP. WOOD FisNC E! V0.00 LF YKis41ur 1"i Eli aamm Twv CONSTRUCTION M 1101-000-4)8-000 %64.00 PLAN; L'4iWX RE 101-C3 0-439-318 $547.49 FFF?'I)El'�3►T 101,�:1t3�?41.15 $2943,I40 MECHAN- TCAly ME 101 -000-421 »tlil!) �lS5; S0 EIACTRIC.A07E 101"t3t' . 420.000 511�,ta:1 P1.,UbIBNl o PEP 101'000-419-000 $116.75 Dftoli0 MOTION F.99 - kl ID 101-000-241-000 3801611 t31it.E RIND IFR, 101-00&.423-000 $20.00 UI ELOP1iii. F,A11 AC:TFEE 51,907.00 P11ECISE VI.AN 101»4110441.345 $110.00 X2:i3-'Ta .AL CORV1'RUCfICN AkJ.D PLAN CHECK LESS PRY -PAW, 19M 4250,00 TOTAL PERMH FUN 1A]t NOW 07C4 !r ; , er Jl7 i v,- PA UUjJq 1 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD' ` OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING" APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing / Compressor Insulation Q Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall. Exterior Lath Drywall - Int. Lath Final Final — 2, POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . Test Final J7 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection /d Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 3 0 Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) _ _ CITY OF LA QUINTA SUB -CONTRA TOR 41ST J06 ADDRESS GZ--TS ��-T,� A PERMIT NUMBER OWNER -+i4 i) tyA- JGte,14 BUILDER U IJ 1�/ C, This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized w on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the id� of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade: / Classification .. ;. Contractor State.Contractor's License Workers Compensation Insurance City Business License . Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name le.g. State Fund, CalCompl Policy Number (Format Varies) bxp. Date (xx/xx/xx) License Number Ixxxxl Exp. Date (xx/xx/xx) EARTHWORK IC -121 7/175o?, C"K CONCRETE :(C,=8) FRAMING (C 5) (✓ ('E I �- STRUGT: STEEL MASONRY (C-29) .. �(� � r-1)VJ L_0E9- PLUMBING (C=36)> %1 Q I� I 0 V �J iO C� �J� 7 4 -AO Vu 'rte �/y9 or LATH PLASTER(C 35). p4r) 6ajSG �0 �� Lo� tiS�R. �12?0lJ�J -014 DRYWALL (C-9) ;l 11 �t II ti tl tl ll tl ll HVAC IC 20).......:.:.... ELECTRICAL:(C=101,;.::: ;: `: ��%�1� ries �. �(i �i - J() j(O 1 eq 6rxT1, F -U P) 2Z C( U tJ t 4H io a 11 /v� o q e4 a/ ROOFING.lC-391 .:::> :. C)A) d OF SHEET:METAL 1 431; :: /" FLOORING (C-16) GLAZING 1c='17 ` GMF - WINOJLU Dlv 7A 15's-01 "-5Ab('e 3WA 40u2A-(o7 4e4 2 36 3 NSULATION (C-2) I .�i �j Uzi Z �j �j �j 3 �i t 0 f U l I� 2 116 EWAGE DISp, (C-42) [PAINTING N (C-33) . CERAMIC ,TILE .IC -54). CABINETS.IC-6i.. of o vl TWD 04-0 -o (I�-ATe UI FENCING IC=131 LANDSCAPING IC -271,' . O UJU 'Q— POOL (C-53) Order No. Escrow No. 20312KC Loan No f lecordhig Requested • By First American Tede, insurance Company • WHEN RECORDED MAIL TO: (Dohn '114 Ivahci'dh Ciel: O ; IvanccYt ; ; �V �7 cc C" z' 44 ui CL �o z Q� _J is 3 SPACE ABOVE THIS LIFOR RECORDER'S USE MAIL TAX STATEMENTS TO:35 75 DOCUMENTARY TRANSFER TAX$........................................................... XX.. ,.. same as above. .Computed on the consideration or value of property conveyed; OR ..... Computed on the consideration or value less liens or encumbrances 4; remaining at time of sale. Signature of Declarant or Agent determining tax — Firm Name GRANT DEED FOR A VALUABLE CONSIDERATION, 'receipt of which is hereby acknowledged, -Jerry F. Myers and Barbara J. Myers, Trustees of Security Mutual Properties Inc. Money • Pension :Plan,.date.d• May'.1, 198.4, t hereby G ANTS) to John M. Ivancich-and Nel 0. Ivancich, husband and wife as joint C\o tenants - . � -.the real property in the,City of La-.Quitita pCounty-of = Riverside h State of California, described as Lot 11 -in Block'166 of"Santa Carmelita at Vale La Quinta Unit #17, as per maps recorded in Book 19, Pages 19 and 20 of maps in the office of the county recorder in said county. Dated M4y'. 1, 1992 STATE OF C . ORNIA. }ss: -COUNTY OF �,dt'S\ 92, } °aOnbefore me, :personally appeared; :Sett .. '%Cx-V1'Ct.,� Y`i1JlGafs \ �)fiiar?c , pememeffy to(or proved to fie on. the basis of satisfactory .r'evidence) to be the-person(s) whose nam@(s) is/are subscribed to the within •- E instrument and acknowledged to me that he/she/they executed the same in his/her/their, authorized capacity(ies), -.and that by his/her/their signa- tures) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITN ha d nd official seal. Y • Sig ture �s000000m0000000000o®000ev00000e �.! . QFMCFAL SEAL Fs.., 'r!RtS"f `d J. CORDELL 171JU IC - cAL oRMfA Pt3MIcIFAL c,.lr.'E w C�P..11TY Ci �. 3�.?q..1�. tCt--ck `"'3.0'a•69•+Sk'6b?^9^M@'rii•ib4'^ID�•9�•4F3'�+a. 1 (This area for official notarial seal) MAIL TAX STATEMENTS AS DIRECTED ABOVE S 1002(1/91) Notice: Document Cannot Be Duplicated Date 12/18/00 No. 21360 Owner NameJohn Ivancich No. 52-715 city La Quinta Tract # Type of Development Comments Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE' APN # 773-281-024 Jurisdiction La Ouinta Street Avenida Diaz zip 92253 Lot # Single Family Residence Permit # 0011-066 Log # Study Area Square Footage 1746 No. of Units 1 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,746 or $ 3,579.30 the property listed above and thai building permits and/or Certificates of Occupancy for this square footage in this proposed project may now'be issued Fees Paid By CASH - John Ivancich - 'Telephone r, Name on the check r By Dr. Doris Wilson Superintendent Fee collected /exe pted by;Annette Barlow Signature Payment Received $3,579.30 Check No. N/A IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified Dove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to ollect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing 'their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY - 78 -495 Calle Tampico La Quinta, CA 92253 (760) 777 7012 AX: (7 ) 777-70 V Z j o -O - R'S '$I ATURE MATE 1 PROPERTY—ADDRESS P RMIT NUMBER(s) (112 - MY/ -o� u�!''GrGv B s P.O. BOX 1504 APPLICATION ONLY I Building� G Ave.8-495 CALLE TAMPICO Address 5 — � l � LA OUINTA, CALIFORNIA 92253 S Owner j` / P (-1 1 G ! t1 Mailing tofV BUILDING: TYPE'CONSTt6_)_OCC. GRP. Address —� A.P. Number �� Legal Descriptio � l 1 t,f/ �'J ,,,,Contractor j, Project Description (� �! `" ( 0 0 IV v 1:�: Z Address City Zip Tel. State Lic. City & Classif.� (.� G521� Lic. # Sq. Ft. No. t No. Dw. Size 1-7 (-'0 Stories ' l_Gwt) Units Arch., Engr., Designer (4� (V �f [� t { New, Add ❑ Alter ❑ Repair ❑ Demolition ❑ Addressp)� 1 Tel. CU V t:� City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION _ I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following -reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter. Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged ezemptfon. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep.D - 00 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I; I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, Mech. provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden Electrical of proving that he did not build or improve for the purpose of sale.) (I 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 11 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3900, Labor Code.) Policy No. Company C7 Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thF work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, atter making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby affirm that there is a construction lending agency for the performance of the s work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by: Date e I I agree to comply with all city and county ordinances and state laws relating to building —� construction, and hereby authorize representatives -of this city to enter the above• I LJ mentioned property for inspection purposes. Validated by: ++ T Signature of a0plicant —Date— Mailing ate Mailing Address Validation: City, State, Zip ,,IT Y ur LA QU1N1_ WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION I Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: Use Classification: Occupancy Group: SINGLE FAMILY DWELLING 52-715 AVENIDA DIAZ R-3' Type of Construction: VN Owner of Building: JOHN IVANCICH ret -C Building Official Bldg. Permit No.: 0011-066 Land Use Zone: RC Address: By: RICHARD KIRKLAND Date: FEBRUARY 20, 2002 POST IN A CONSPICUOUS PLACE